Association between bisphosphonates and survival: nitrogen versus non-nitrogen containing bisphosphonates — ASN Events
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Association between bisphosphonates and survival: nitrogen versus non-nitrogen containing bisphosphonates (#140)

Dana Bliuc 1 , Thach Tran 1 , Tineke van Geel 2 , Jonathan Adachi 3 , Claudie Berger 4 , Joop van den Bergh 5 , John A Eisman 1 6 7 , Piet Geusens 5 , David Goltzman 8 , David A Hanley 9 , Robert Josse 10 , Stephanie Kaiser 11 , Christopher S Kovacs 12 , Lisa Langsetmo 13 , Jerilynn Prior 14 , Tuan V Nguyen 1 7 , Jackie R Center 1 7
  1. Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Darlinghurst, NEW SOUTH WALES, Australia
  2. Department of Family Medicine, CAPHRI – School for Public Health and Primary Care , Maastricht University,, Maastricht, , The Netherlands
  3. Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. CaMos National Coordinating Centre, McGill University, Montreal, Quebec, Canada
  5. Maastricht University Medical Center, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht, The Netherlands
  6. School of Medicine, University of Notre Dame, Sydney, NSW, Australia
  7. Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia
  8. Department of Medicine, McGill University, Montreal, Quebec, Canada
  9. Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  10. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  11. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  12. Faculty of Medicine, Memorial University, St. John’s, Newfoundland, Canada
  13. School of Public Health, University of Minnesota, Twin Cities, Minneapolis, United States of America
  14. Department of Medicine and Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada

Background: Bisphosphonates, potent anti-fracture agents may be associated with improved survival in those at risk for fracture. The newer nitrogen containing bisphosphonates are more potent than the non-nitrogen bisphosphonates. However, there is no information on whether they have different effect on mortality risk.

Objectives: To determine the relationship of n-BP (alendronate, risedronate) compared with non-n-BP (etidronate) with mortality risk.

Setting: Population-based cohort participating in the Canadian Multicentre Osteoporosis Study from 9 centres across Canada between 1996 and 2011

Design: Prospective follow-up of pairs of bisphosphonate users matched to non-users. Matching was based on a propensity score including age, fracture type, gender, bone density and co-morbidities with the condition that the non-treated pair is alive at time of bisphosphonate commencement.

Participants: 5286 women and 2102 men aged 50+ with and without osteoporotic fracture.

Main Outcome Measure: Pair-wise Cox proportional hazards model. Results: There were 2048 women and 308 men on BP. In the multivariable analysis adjusting for all potential confounding, mortality risk was lower for BP users in both women [HR 0.63 (0.53-0.75)] and men [HR 0.72 (0.55-0.94)]. The association between BP type and mortality risk was explored in three separate 1:1 propensity score-matched cohorts of women on BP and no treatment (alendronate, n=422, etidronate n=599, and risedronate n=213) (Figure). Alendronate and risedronate were associated with lower mortality risk [multivariable HR, 0.60 (0.38-0.93) and 0.52 (0.25-1.09), for alendronate and risedronate, respectively] while etidronate was not [HR: 0.88 (0.63-1.25)]. Subsequent fracture risk was reduced non-significantly by N-BP (alendronate/risedronate) [HR 0.77 (0.49-1.21)] versus etidronate [HR 2.09 (0.98-4.44)]. The findings were similar for men and for the fracture subgroup.

Conclusion: Nitrogen but not non nitrogen BPs appear to be associated with better survival independent of co-morbidity, demographic, and lifestyle variables in both genders. These findings require further confirmation but support studies investigating potential mechanisms.58c223023f0b9-Figure.jpg